Training Title 114
Name: Ally Chen
Gender: female
Age: 44 years old
Background: Only child, raised by parents in Philadelphia, PA. Has PhD in biology and master’s
degree in high school education (8–12). Her supervisor has asked the school EAP counselor to
intervene with concerns regarding potential substance use in effort to facilitate getting her help
and be able to retain her. She is divorced, has a 4-year-old son who lives with his father. Appetite
healthy, sleeping 9 hours/24 hrs., wakes 2-3 times during the night. Denied drug use. had DUI
when she was age 21.
Symptom Media. (Producer). (2018). Training title 114-2 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-114-2

NRNP 6635 Case History Report – Week 8: Substance‑Related and Addictive Disorders
Training Title 114: Ally Chen
1. Introduction
Patient: Ally Chen, 44‑year‑old female.

Context: Case study from Symptom Media video (2018).

Clinical Focus: Substance‑related and addictive disorders in professional adults, workplace intervention, psychosocial stressors.

Importance: Highlights how substance use concerns can emerge in high‑functioning individuals, requiring early intervention to prevent occupational and personal decline.

2. Demographics and Background
Age: 44 years old.

Gender: Female.

Residence: Philadelphia, PA.

Family: Only child, divorced, has a 4‑year‑old son who lives with his father.

Education/Occupation:

PhD in biology.

Master’s degree in secondary education (grades 8–12).

Works as a high school educator.

Medical History: No chronic illnesses reported.

Psychiatric History: Denies drug use; history of DUI at age 21.

Lifestyle: Healthy appetite, sleeps ~9 hours/day but wakes 2–3 times nightly.

Social History: Divorced, limited family support, balancing career and motherhood.

3. Psychosocial Stressors
Workplace Concerns: Supervisor requested EAP counselor intervention due to suspected substance use.

Family Stress: Divorce, son lives with father → possible feelings of loss or guilt.

Social Isolation: Only child, limited family network.

Past Legal Issue: DUI at age 21 suggests prior alcohol misuse.

Occupational Pressure: High academic achievement, professional demands, stress of teaching adolescents.

4. Clinical Presentation (Substance Use Disorder Features)
Reported Symptoms:

Denies current drug use.

History of DUI raises suspicion of alcohol misuse.

Sleep disturbance (frequent waking).

Behavioral Indicators:

Supervisor concern suggests observable impairment (e.g., absenteeism, performance decline, behavioral changes).

Possible concealment of substance use.

Risk Factors:

Past DUI.

Divorce and custody stress.

Occupational stress.

Family history unknown (no details provided).

5. Mental Status Examination (MSE)
Appearance: Professional, well‑educated, likely well‑groomed.

Behavior: Cooperative but possibly defensive regarding substance use.

Speech: Normal rate/volume.

Mood: Neutral or anxious.

Affect: Constricted, tense.

Thought Process: Logical, coherent.

Thought Content: Denies substance use, may minimize concerns.

Cognition: Alert, oriented ×3.

Insight/Judgment: Limited, denies problem despite workplace concerns.

6. Differential Diagnosis
Alcohol Use Disorder (mild/moderate): Past DUI, workplace concerns.

Sedative/Hypnotic Use Disorder: Possible if sleep disturbance leads to self‑medication.

Adjustment Disorder: Stress from divorce and custody issues.

Depression/Anxiety Disorders: Sleep disturbance, occupational stress.

Medical Causes: Sleep apnea, thyroid dysfunction (must be ruled out).

7. Diagnostic Considerations (DSM‑5)
Substance Use Disorder Criteria:

Impaired control.

Social impairment.

Risky use.

Pharmacological criteria (tolerance, withdrawal).

Ally’s Case:

Denies use, but workplace concerns and DUI history suggest possible alcohol use disorder.

Sleep disturbance may be secondary to stress or substance use.

8. Assessment Tools
AUDIT: Alcohol use severity.

DAST‑10: Drug abuse screening.

CAGE Questionnaire: Alcohol dependence.

PHQ‑9: Depression screening.

GAD‑7: Anxiety screening.

Collateral Information: Supervisor and workplace reports critical.

9. Treatment Plan
Pharmacological:

If alcohol use confirmed:

Naltrexone or acamprosate for alcohol dependence.

SSRIs for comorbid depression/anxiety.

Sleep hygiene interventions before sedative prescription.

Psychotherapy:

Motivational interviewing.

CBT for stress and coping.

Family therapy (custody stress).

Relapse prevention therapy.

Lifestyle Interventions:

Structured routine.

Sleep hygiene.

Stress management techniques.

Nutrition and exercise.

Supportive Measures:

EAP counseling.

Peer support groups (AA, NA).

Case management.

10. Monitoring and Follow‑Up
Regular psychiatric visits.

Workplace monitoring via EAP.

Substance use screening.

Suicide risk reassessment.

Collaboration with family and healthcare team.

11. Challenges
Denial: Patient denies substance use despite workplace concerns.

Stigma: Professional stigma around addiction.

Family Stress: Divorce, custody issues.

Occupational Stress: High demands of teaching.

Sleep Disturbance: May worsen functioning.

12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy, especially workplace involvement.

Consent: Informed consent for treatment.

Safety: Risk management for impairment at work.

Cultural Sensitivity: Address stigma in professional women.

13. Case Summary
Ally Chen: 44‑year‑old female, highly educated, divorced, with workplace concerns about substance use.

Likely Diagnosis: Possible alcohol use disorder, adjustment disorder, or stress‑related condition.

Treatment: Comprehensive assessment, motivational interviewing, CBT, workplace support, lifestyle interventions.

Outcome Goal: Clarify diagnosis, reduce risk, improve functioning, retain employment, enhance quality of life.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Ally’s age? a) 42 b) 44 c) 46 d) 48

Where was Ally raised? a) Boston, MA b) Philadelphia, PA c) Charleston, SC d) Dallas, TX

What is Ally’s highest degree? a) Master’s in education b) PhD in biology c) Bachelor’s in psychology d) Associate’s degree

What occupation does Ally hold? a) College professor b) High school educator c) Research scientist d) Social worker

Who intervened with concerns about Ally’s substance use? a) Her sister b) Her supervisor via EAP counselor c) Her ex‑husband d) Her physician

What family situation may contribute to stress? a) Caring for elderly parents b) Divorce and custody of son c) Financial debt d) Chronic illness

What legal history is relevant? a) DUI at age 21 b) Arrest for drug paraphernalia c) Assault charge d) None

How many hours does Ally sleep daily? a) 6 b) 7 c) 9 d) 11

How often does Ally wake during the night? a) Once b) 2–3 times c) 4–5 times d) Never

Which screening tool assesses alcohol dependence? a) CAGE b) PHQ‑9 c) GAD‑7 d) AIMS

Which therapy is useful for workplace‑related substance concerns? a) Motivational interviewing b) Psychoanalysis c) Electroconvulsive therapy d) Dialectical behavior therapy

Which medication may be used for alcohol dependence? a) Naltrexone b) Lithium c) Clozapine d) Haloperidol

What supportive measure is workplace‑based? a) EAP counseling b) Family therapy c) Peer support groups d) Case management

What challenge complicates Ally’s case? a) Denial of substance use b) Severe medical illness c) Lack of education d) Financial debt

What is the primary outcome goal for Ally? a) Retain employment and improve functioning b) Relocate to another city c) Gain custody of son immediately d) Avoid all medical treatment